Enhanced recovery after surgery protocol implementation in pediatric Meckel's diverticulum resection: A clinical outcome study.

BACKGROUND: Enhanced recovery after surgery (ERAS) guidelines have been established for multiple types of adult surgeries. However, ERAS guidelines tailored to pediatric surgeries remain to be developed. AIM: To evaluate the clinical outcomes of ERAS protocols in pediatric laparoscopic Meckel's diverticulum resection. METHODS: This retrospective cohort study analyzed 78 consecutive pediatric cases treated between January 2017 and March 2025. Patients were divided into: Traditional care group (n = 38): January 2017-December 2020; ERAS protocol group (n = 40): January 2021-March 2025. We compared perioperative outcomes, including clinical recovery parameters and laboratory markers, to assess protocol efficacy. RESULTS: All procedures were completed laparoscopically by the same surgical team without conversion. Baseline characteristics, including demographics, diverticulum location, and intraoperative parameters (operative time, blood loss), were comparable between groups (all P > 0.05). The ERAS protocol demonstrated significantly shorter postoperative length of stay (7.55 ± 1.52 days vs 10.40 ± 3.59 days, P < 0.001) while complication rates were numerically lower in the ERAS group (17.50% vs 13.16%, P = 0.595). Additional benefits of ERAS implementation included: Reduced intravenous fluid requirements (5.00 mL/kg/hour vs 8.00 mL/kg/hour), accelerated gastrointestinal recovery (first flatus: 2.00 days vs 3.00 days), lower pain scores (P < 0.001), earlier total enteral nutrition achievement (5.00 days vs 6.50 days) and shorter intravenous therapy duration (6.00 days vs 8.00 days; all P < 0.001). ERAS patients also showed reduced drainage utilization (P < 0.05) and improved inflammatory marker profiles postoperatively [neutrophils: (5.98 ± 2.02) × 109/L vs (8.01 ± 3.98) × 109/L]; median C-reactive protein: 13.6 mg/L 7 vs 19.63 mg/L). Glycemic control was superior in the ERAS group despite higher induction levels (both P < 0.05). Parental satisfaction (92.50% vs 86.84%) and 30-day readmission rates (2.50% vs 2.63%) showed no significant differences. CONCLUSION: ERAS protocols safely optimize recovery in children undergoing laparoscopic Meckel's diverticulum resection, significantly reducing length of stay while improving pain management and overall clinical outcomes. These findings support the adoption of ERAS in pediatric intestinal surgery.